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Rhode Island’s health marketplace

Rhode Island utilizes a state-run health insurance exchange – HealthSource RI – an active purchaser exchange. That means that the exchange negotiates directly with insurers, and determines which plans will be made available each year.

In most states, enrollments outside of open enrollment (ie, during a special enrollment period) must be completed by the 15th of the month in order to have coverage effective the first of the following month. But Rhode Island is one of just two states where the deadline is the 23rd of the month.

Medicaid expansion in Rhode Island

Immediately after the Supreme Court ruled in 2012 that Medicaid expansion would be optional for the states, Former Gov. Lincoln Chafee made it clear that Rhode Island would be implementing Medicaid expansion. At the time, Rhode Island estimated that about 40,000 additional people would enroll in Medicaid through 2022, with most of them (about 83 percent) being newly-eligible as a result of Medicaid expansion. But the state noted that there was considerable uncertainty in terms of how many people would actually be newly-eligible and newly-enrolled.

As of late 2019, Medicaid/CHIP enrollment in Rhode Island was 53 percent higher than it had been in 2013, and included more than 100,000 additional enrollees. In that timeframe, the state has seen a 64 percent reduction in the uninsured rate, from 11.6 percent uninsured in 2013 to 4.1 percent uninsured in 2018.

Short-term health insurance in Rhode Island

The sale of short-term health insurance plans is not banned in Rhode Island, but due to its strict regulations, no insurers offer short-term plans in the state. The state’s restrictions include a mandate that all plans sold in the state must cover essential health benefits, cover pre-existing conditions, and premiums cannot be based on medical history.

No short-term health plans have been approved for sale in the state for several years.

How has the ACA helped Rhode Island?

With a state-based health insurance exchange (HealthSource RI) and Medicaid expansion, Rhode Island has fully embraced the Affordable Care Act. And, the healthcare reform law has been quite effective for the state. Rhode Island has seen the ninth-largest reduction in the percentage of residents without health insurance since 2013 and now has one of the nation’s lowest uninsured rates.

The Rhode Island exchange enrolled about two and a half times as many people in expanded Medicaid than in private plans during the 2014 open enrollment period, so Medicaid expansion has played a key role in reducing the number of uninsured residents in the state.

Rhode Island and Obamacare

In 2010, Rhode Island’s U.S. Senators – Democrats John Reed and Sheldon Whitehouse – both voted yes on the ACA. In the U.S. House, both of the state’s Representatives were also Democrats – Patrick Kennedy and Jim Langevin – and voted yes.

Kennedy has since been replaced by another Democrat, David Cicilline, who is also supportive of the ACA and has stated that “protecting the programs created through the recent health care reform is one of [his] top priorities in congress.” Thus, the entire U.S. congressional delegation from Rhode Island is Democratic and supportive of healthcare reform.

Rhode Island’s state legislature also has a very strong Democratic majority. Former Gov. Lincoln Chaffee, a Democrat, was an ardent supporter of the law, “fully committed to ensuring that Rhode Island is a national leader in implementing health reform …” Chaffee has since been replaced by Gov. Gina Raimondo, a Democrat who took office in 2015 and is strongly invested in healthcare reform.

The state has been fully on-board with ACA implementation from the get-go, opting for a state-run exchange (HealthSource RI) and agreeing to expand Medicaid to cover all of the state’s legal residents with incomes up to 138 percent of poverty.

In late spring 2014, there was some talk in the legislature about switching to a federally-facilitated exchange in order to be more cost-effective, but that ultimately did not happen and the state is still running the exchange.

Medicare in Rhode Island

As of February 2020, there were 222,641 Rhode Island residents enrolled in Medicare. About 48 percent are enrolled in Medicare Advantage plans, while the rest have Original Medicare.

State-based health reform legislation

In 2018 and 2019, Rhode Island enacted legislation to implement a state-based individual mandate starting in 2020, and to create a reinsurance program to stabilize the state’s individual insurance market (the reinsurance program was subsequently approved by the federal government and took effect in 2020).